Question

J.J., a 55-year-old white male, has come in for his annual physical. He has hypertension and type 2 diabetes mellitus. His blood pressure is controlled with lisinopril 20 mg daily and amlodipine 5 mg daily (BP 132/82 mm Hg). His most recent HbA1c was 7.2% while taking metformin. His father died at age 55 of a myocardial infarction, and his brother, age 57, just underwent angioplasty. J.J. eats fast food at least five times a week because of his work schedule. He weighs 245 lbs. and stands 5-foot-11. His blood pressure is 134/80. His total cholesterol is 237 (LDL, 162; HDL, 35; triglycerides, 200).

Answer the following questions. Include two references, cited in APA style.

Does J.J. fall into any of the statin risk categories? If so, which one?

What drug therapy and dose would you prescribe, and why?

What are the parameters for monitoring the success of the therapy?

List one or two adverse reactions for the drug therapy that you prescribed for J.J. that would cause you to change therapy.

When rechecked, J.J.’s total cholesterol is 174 (LDL, 100; HDL, 38), but he is complaining of muscle pain. How would you manage J.J.’s treatment?

Answer 1

Statin risk categories :
** National trends in statin use by coronary heart disease risk categories J.J having a chance to fall in statin risk categories because of his hypertension and family history of father and brother with coronary heart disease..His fast food habits elevated his cholestrol level..because hyperlipidemia represents an important modifiable risk factors in the development and pregression of CHD..if bolld cholestrol more than 240mg/dl and triglycerides more than 190mg/dl LDL more than 190mg/dl and HDL greater than 40 to 60mg/dl considered as a hyperlipidemia..
Drug therepy and dosage:
   ** drug therepies include 3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors known as statins....Most commonly used drug for initial stage pravastatin 40mg and simvastatin 20mg. this drug can be tolerated and effective drug for reducing LDL-c levels and CHD events..this drug is for only patient with high risk and LDL-c is high inadequency controlled with lifestyle modification alone can be given..
Para meters for monitoring the therepy:
    ** check base line lipids,liver function test and creatinine phosphokinase(CK)
-advice patient about drug therepy and adverse reaction
-Medicine should be taken in the evening for high good result and need 4weeks or more to lower the lipid concentration..
-check LFT every 6months
-Review every 4-6weeks and inform if there is any side effects
-If lipid is under control and no adverse effects review again then every 6-12 months..
-If lipid is not under control adjust the dosage and repeat after 6weeks.
-LFT should be measures on 3 occasions basic liver enzymes before starting a statin and liver function test(transaminases) within 3months of starting treatment and at 12months
-treatment should be withhold or stopped if serum transaminases is high..
-Advice the patient to see the doctor if there is any muscle pain..
Adverse reactions:
   **Liver function becomes too abnormal.Myopathy involving actual damage of muscle tissue..in this condition drugs are not stopped can lead to dangerous condition called rhabdomyolysis
Management:
   **statin having adverse effects called myopathy,myositis,myalgia..some suggestion if elevated creatinine kinase more than 10times the upper limit that time statin should be stopped..and now J.J having muscle pain and his cholestrol level within normal limit so reduce the adverse effect statin should be stopped immediately..but he should be carefully monitor for muscular symptoms and cardiovascular risk...